Congress moves to strip PBMs of hidden drug markups, mandate pharmacy access

What it does

This bill restricts pharmacy benefit managers (PBMs) from taking profits beyond flat-fee compensation for services, requires them to disclose detailed drug pricing and rebate data to Medicare plans, mandates that any willing pharmacy can join Medicare drug plan networks, and establishes enforcement mechanisms including civil penalties for violations. It also requires the Secretary of Health and Human Services to publish reports on pharmacy access and PBM compensation structures, and extends similar transparency and accountability rules to PBMs serving employer health plans.

Why we flagged it

The bill's core mechanism is a structural prohibition on PBM profit-taking beyond flat fees, paired with mandatory disclosure of pricing, rebates, and compensation data. This is regulatory reform targeting market opacity and conflicts of interest in drug distribution, not a subsidy, carve-out, or commemorative measure.

What the text implies

• PBMs may respond by raising flat-fee amounts to compensate for lost rebate revenue, potentially shifting costs from hidden markups to transparent but higher service charges—benefiting transparency but not necessarily lowering total plan costs.
• The 'any willing pharmacy' requirement may strain network quality controls and increase administrative burden on plans, though it expands beneficiary choice and may reduce PBM steering toward affiliated pharmacies.
• Mandatory disclosure of affiliate pharmacy dispensing rates and cost comparisons creates pressure on PBMs to justify higher costs at affiliated entities, potentially forcing divestitures or restructuring of vertically integrated PBM-pharmacy models.
• The bill's reliance on Secretary rulemaking to define 'bona fide service fees' and 'fair market value' creates implementation risk; weak rules could allow PBMs to repackage rebates as fees, while strict rules could disrupt legitimate service arrangements.
• Reporting requirements impose significant compliance costs on PBMs and plans, which may be passed to employers and ultimately to workers through higher premiums, offsetting some beneficiary savings.

Section numbers refer to the bill text the analysis read — linked under Primary records below.

Who it affects

Medicare beneficiaries and employer plan members gain access to more pharmacies, lower out-of-pocket costs through reduced hidden PBM markups, and greater price transparency. PBMs are restricted from deriving revenue beyond bona fide service fees, which eliminates conflicts of interest that inflate drug costs. The enforcement mechanism and reporting requirements create accountability that was previously absent.

Who stands to gain

• Medicare beneficiaries (lower out-of-pocket costs, expanded pharmacy access)
• Employer plan members (transparency, reduced hidden markups)
• Independent and retail pharmacies (access to networks, reduced steering to PBM affiliates)
• Generic and biosimilar manufacturers (reduced formulary discrimination)

Named in the bill

Centers for Medicare & Medicaid Services (CMS), Pharmacy Benefit Managers (PBMs), Medicare Advantage organizations, PDP sponsors, Retail pharmacies, Drug manufacturers, Health insurance issuers, Comptroller General, Medicare Payment Advisory Commission (MedPAC), Office of Inspector General (HHS), Bristol Myers Squibb (BMY), Gilead Sciences (GH) — and 3 more

Where it stands

71 cosponsors: 40 Republicans, 31 Democrats.

• Jul 10, 2025 — Introduced · Congress.gov: “Introduced in House”
• Jul 10, 2025 — Referred to House Committee on Ways and Means and House Committee on Education and Workforce · Congress.gov: “Referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and…”

Dates and quoted wording are Congress.gov's action record; the timeline shows status changes, not every procedural step.

Money around this bill

33 lobbying clients named this bill on 42 disclosure filings across 2 quarters, Dec 2025 to Jun 2026. Those filings disclosed $38,474,705 in lobbying spend. A filing names 11 bills on average, so that figure is what each filing reported, not a share belonging to this bill.

More lobbying clients named this bill than 98% of bills with at least one filing.

Buddy Carter, the sponsor, reported $988,325 in PAC receipts in the 2026 cycle. $5,000 of that came from 1 PAC tied to these lobbying clients.

• Pharmaceutical Research and Manufacturers of America — $15,770,000 on 2 filings
• Pharmaceutical Care Management Association — $6,472,656 on 2 filings
• CVS Health (and Subsidiaries) — $3,570,000 on 1 filing
• America's Health Insurance Plans Inc (ahip) — $3,010,000 on 1 filing
• Amgen Inc — $2,440,000 on 1 filing

Lobbying Disclosure Act filings through Jul 20, 2026. A filing shows who paid to lobby on a bill it names, not what changed.